da Vinci® Surgical Options in the Best Interest of Women

By Kelly Merritt

Laparoscopic surgery, also called minimally invasive surgery, has long been known to produce better surgical outcomes for patients. da Vinci® surgery (commonly called robotic surgery) is transforming laparoscopic surgery for patients, especially for women with endometriosis.

NCH’s Holly Raass Miller, MD has dedicated her life to the advancement of medical treatments for women. She received advanced training on the da Vinci® Surgical System while in private practice in Jackson, TN. Her special area of interest is minimally invasive surgery, including da Vinci® surgery, but she also offers comprehensive obstetrics and gynecology services.

Endometriosis is one of the most common gynecologic diseases affecting more than 5.5 million women in North America alone. This affliction occurs when tissue that is normally inside the uterus is found on the outside of the uterus. With each menstrual cycle the tissue bleeds, resulting in pain and often forming scar tissue.

“Many physicians choose to try to ablate or burn endometriosis with a traditional laparoscope, but this may leave deeper tissue still affected by the disease. So the use of robotic-assisted surgery for endometriosis allows for better identification of abnormal versus normal areas of tissue, thanks to the excellent visualization offered by the magnified, 3-D high-definition camera,” Dr. Miller says. “I am able to carefully identify critical anatomic structures, restore normal pelvic anatomy and work carefully to excise all areas of abnormal tissue that can be safely removed.”

For a majority of women undergoing surgery for endometriosis, keeping their reproductive organs for future pregnancy is important. “By removing maximal amounts of endometriosis without removing the uterus, tubes or ovaries, we will still preserve the ability to bear children,” she says. da Vinci® surgery works similarly to all laparoscopic procedures, with small incisions made in the abdomen and instruments placed into those incisions.

With robotic surgery, instruments are attached to the arms of the robot while the surgeon sits a few feet away and looks at a three-dimensional image.

“The surgeon then moves her hands as if she was directly touching, cutting and suturing the tissue and the robot translates these movements with exact precision. It is designed to pivot in a way that minimizes pain at the incision,” she says.

Having a three-dimensional image improves surgical accuracy and allows operations on very complex problems. “And because the surgery makes it unnecessary for women to have a large abdominal incision, there are fewer external scars and fewer internal adhesions because there is less tissue manipulation,” Dr. Miller says. “The outcome for patients is a decrease in pain, minimal blood loss and a faster return to normal life,” she adds.

Any woman who needs gynecological surgery is eligible to be considered for da Vinci® procedures.

“Most women think only of hysterectomy (removal of the uterus or womb) as a gynecological surgery, but we also use this technology to fix vaginal prolapse, to remove fibroids in the uterus and to resect endometriosis,” she says.

NCH has the newest robot available, the da Vinci® Si System, at both NCH Downtown Naples and North Naples hospital locations.

“Women should never accept it when someone says, ‘You have to have a large incision on your abdomen’. Just because your physician cannot provide da Vinci® surgery doesn’t mean another surgeon can’t,” Dr. Miller says.